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LABORATORY:

HEMATOLOGY
March 16, 2013 TEST Hemoglobin DEFINITION It is the main component of red blood cells. Its main function is to carry oxygen from the lungs to the body tissues and to transport Carbon Dioxide, the product of cellular RESULT 164 REFERENCE RANGE (140-175 g/ml) INTERPRETAT CLINICAL ION SIGNIFICANCE Normal Elevated level denotes for hemato concentration and polycythemia. Decreased level denotes for hemorrhage, anemia or hemodilution ( overhydartion ).

Hematocrit

Leukocytes (WBC)

metabolism, back to the lungs. It is the measurement of the percentage of red blood cells in the total volume of blood. It is expressed as the percentage of red cells in the total blood volume. The total white blood count (WBC) is the absolute number of white blood

0.48

(0.415- 0.504)

Decreased

Elevated level may account for hemoconcentrati on and polycythemia vera. Decreased level may account for anemia, acute blood loss or hemodilution. Elevated level accounts for anemia. Decreased level

10.9

(4.8- 10.8)

Increased

Platelet Count

cells (leukocytes) circulating in a cubic millimeter of blood Also called thrombocytes, are large, nonnucleated cells derived from the megakaryotes produced in the bone marrow. They promote coagulation.

may account for anemia or bone marrow transplant.

228

150-400

Normal

Elevated level signifies thrombocytosis resulting from hemorrhage, surgery, chronic inflammatory disease

TEST Eosinophil

DEFINITION They play a role in allergic reactions, possibly inactivating histamine.

RESULT 0.01

REFERENCE RANGE (0.02-0.08)

INTERPRETAT CLINICAL ION SIGNIFICANCE Decreased Elevated level on eosinophil count may be caused by hyperimmune or more or allergic reaction where there is antigenantibody response. Decreased eosinophil count may be associated with congestive heart failure or anemia

Lymphocyte

They play a role in our immune response.

0.09

(0.19-0.48)

Decreased

Elevated level may be associated with presence of viral infection and hormonal disorders. Decreased level may account for burns, trauma and the administration o corticosteroids . Elevated level accounts for inflammatory process, leukemia,

Basophil

They contain histamine and heparin and appear to be involved

0.00

(0.00-0.05)

Normal

in immediate hypersensitivit y reactions.

healing stage of infection. Decreased level accounts for stress or hypersensitivit y reactions. Elevated level accounts or viral diseases or monocytic leukemia. Decreased level accounts for lymphocytic leukemia and aplastic anemia.

Monocyte

They are the second line of defense against bacterial infections and foreign substance.

0.03

(0.00-0.15)

Normal

Neutrophils

Most numerous circulating WBCs and they respond more rapidly to the inflammatory and tissue injury sites than other types of WBCs.

0.88

(0.40-0.70)

Increased

Increased level denotes presence of a bacterial or aplastic infectious process. Decreased levels may be caused by hematoloic diseases and acute viral infecrion.

DRUG STUDY
Name of Drug: MANNITOL It works by Classification: increasing the Diuretic amount of fluid excreted Dosage/ Frequency: by the kidneys 100cc IV q6 and helps the Fast Drip body to decrease pressure in the brain and eyes. Mechanism of Action: Indications: Contraindi cations: Mannitol is used to you are force urine allergic production to any in people ingredient with acute in (sudden) Mannitol kidney you have failure. a history Increased of heart urine failure production you have helps decreased prevent the or absent kidneys from production shutting of urine down, and due to also speeds severe up kidney elimination disease, Adverse Reactions: dry mouth, increased thirst, blurred vision, or seizure (convulsio ns); swelling, pain, or skin changes where the medicine was injected; chest Nursing Considerations: Mannitol may cause dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Mannitol with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Use Mannitol with caution in the ELDERLY; they may be more sensitive to its effects. Mannitol should be used with extreme

of certain toxic substances in the body. Mannitol is also used to reduce swelling and pressur inside the eye or around the brain.

certain severe lung problems (eg, pulmonary congestion or pulmonary edema), bleeding in the brain, or severe dehydration

pain, fast caution in CHILDREN heart younger than 12 years rate; old; feeling safety and like you effectiveness in these might pass children have not been out; confirmed. feeling short of breath, even with mild exertion; swelling, rapid weight gain; or if you stop urinating.

Name of Drug: Phenytoin

Mechanism of Action:

Indications:

Treating Classification: It works by certain types Anticonvulsant slowing down of seizures impulses in (eg, status Dosage/ the brain that epilepticus). Frequency: 100mg cause seizures. It is also IV q8 used to prevent and treat seizures that may occur during or after brain or nervous system surgery. It may also be used for other conditions as determined by your

Contraindications: Adverse Nursing Reactions: Considerations: you are allergic to any ingredient Constipation; Phenytoin may cause in Phenytoin or to dizziness; dizziness. This another hydantoin headache; effect may be worse (eg, fosphenytoin) mild if you take it with you have certain nervousness; alcohol or types of heart nausea; certain medicines. problems (eg, very trouble Use Phenytoin with slow heart beat, sleeping; caution. Do not certain types of vomiting. drive or perform heart other possibly block, Adams-Stokes unsafe syndrome) tasks until you know how you react to it. Check with your doctor before you drink alcohol while you are taking Phenytoin . Alcohol may increase or decrease the amount of medicine in your

doctor.

blood. Do not change brands or dose forms (eg, tablets, suspension, injection) of Phenytoin without talking with your doctor. Do NOT take more than the recommended dose without checking with your doctor. Phenytoin may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If

these symptoms occur, tell your doctor right away.

Name of Drug: Ranitidine

Mechanism of Action:

Indications: Acute duodenal or gastric ulcer and gastroesophageal reflux

Contraindications: Contraindicated to patients hypersensitive to the drugs and use cautiously in patients with impaired renal and hepatic function.

Adverse Nursing Reactions: Considerations: Hepatic: jaundice Skin: rash CNS: malaise GI: abdominal discomfort EENT: blurred vision Monitor patient for adverse reactions, especially hypotension and arrhythmias. Peridically monitor lab tests, such as cbc and renal and hepatic studies.

Competitively Classification: inhibits action of Histaminehistamine2 receptor receptor antagonist sites of parietal Dose and cells, Frequency: decreasing 50 mg IV q12 gastric acid secretion.

Name of Drug: Mechanism of Indications: ContraAction: Infections causedindication: Ceftiaxone Semisynthetic by susceptible Hyperthirdgeneratio organisms in sensitivity Classification n lower respiratoryto cepha: cephalosporin tract, skin and losporins antiinfective; antibiotic. skin structures, and related antibiotic; Preferentially urinary tract, antibiotics; thirdbinds to one bones and joints;pregnancy generation or more of also intra(category B) cephalosporin penicillin- abdominal binding infections, Dose and proteins pelvic Frequency: (PBP) inflammatory 1gm IV q12 located on disease, cell walls of uncomplicated susceptible gonorrhea, organisms. meningitis, and This surgical Inhibits prophylaxis third and final stage of bacterial cell wall

Adverse Reactions:

Nursing Considerations:

Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of other allergies, particularly to drugs, before therapy is initiated.

BodyWhole:Pruritus, fever, chills, pain, induration at IM injection site; phlebitis (IV site). GI: Diarrhea, abdominal cramps, pseudomembranous colitis, biliary sludge. Urogenital:Genital pruritus; moniliasis.

Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy.

synthesis, thus killing the bacterium.

Dosage may be started pending test results. Periodic coagulat ion studies (PT and INR) should be done.

Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness, swelling, pain).

Monitor for manifestations of

hypersensitivity . Report their appearance promptly and discontinue drug.

Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears to alter vitamin Kproducing gut bacteria; therefore, hypoprothrombinem ic bleeding may occur.

Check for fever if diarrhea occurs: Report both promptly. The incidence of antibioticproduced pseudomembranous colitis is higher than with most cephalosporins. Most vulnerable patients: chronically ill or debilitated older adult patients undergoing abdominalsurgery.

NURSING CARE PLAN


ASSESSMENT
Objective Cues: limited range of motion inability to perform gross motor skills difficulty upon turning unable to transfer to bed decreased muscle strength

NURSING DIAGNOSIS
Impaired Physical Mobility r/t Sensoriperceptual Impairment secondary to Injury and bedrest

PLANNING
Within 8 hours of nursing interventions, the patient will be able to maintain strength and function of affected body part as evidenced by absence of contractures and footdrop

INTERVENTION
Review functional ability and reasons for impairment

RATIONALE
Identifies Probable functional impairments and influences choices of interventions

EVALUATION

Within the 8 hours of Nursing interventions the patient was able to maintained strength and Provide/ assist Maintains function of with range of mobility and affected body motion exercises. function of part as joints/functional evidence by alignment of absence of extremities and contractures reduces venous and footdrop stasis the goal was met

Place the client in designated therapeutic position

Designated therapeutic position should cause no undue stress on muscles or joint

Apply a foot A foot board will board to the bed prevent foot drop Elevate the head The head of the of bed, as bed may be appropriate elevated to provide counteraction of for comfort if permitted Place frequently Placing used objects frequently used within reach objects within reach permits the client safe and

convenient access. Provide meticulous skin care, remove wet linen/clothing and keep bedding free from wrinkles Monitor bowel elimination and provide for/ assist with a regular bowel routine Promotes circulation and skin elasticity and reduces risk of skin excoriation

A regular bowel routine requires simple but diligent measures to prevent complications